EFFICACY OF OZONE THERAPY IN THE TREATMENT OF LUMBAR DISC HERNIATION: A SYSTEMATIC REVIEW OF 1098 PATIENTS' RESULTS

Year 2022, , 707 - 713, 27.12.2022

Z Işık Solak Görmüş , Melda Pelin Yargıç , Murat Cenk Çelen

https://doi.org/10.17343/sdutfd.1120969

Abstract

Ozone therapy is widely used in the treatment of
lumbar disc herniation with intradiscal injection and
paravertebral intramuscular injection routes. This
study aims to evaluate the efficacy of ozone therapy
in the treatment of lumbar disc herniation according
to the results of randomized controlled trials. 105
articles obtained as a result of a search in Pubmed,
Google Scholar and Science Direct databases were
examined, and 9 randomized controlled studies were
included in the systematic review. In studies, it has
been observed that ozone is used in concentrations
ranging from 20 μg/ml to 60 μg/ml by intradiscal or
paravertebral route. While only ozone application can
be done in studies, it has been determined that some
studies use the effect of ozone injection in combination
with other treatment methods. It was seen that pain
was measured with a visual analog scale as the
primary output criterion of the studies. The results
of randomized controlled studies show that ozone
therapy gives more effective results in the treatment of
lumbar disc herniation compared to conventional drug
therapy, and increases the effectiveness of treatment
when added to other minimally invasive treatments. It
also leads to less hospital stay and lower treatment
costs compared to surgery.

Keywords

low back pain, ozone, intervertebral disc herniation

LOMBER DİSK HERNİSİ TEDAVİSİNDE OZON TERAPİNİN ETKİNLİĞİ: 1098 HASTANIN SONUÇLARININ SİSTEMATİK DERLEMESİ

Abstract

Ozon terapi, lomber disk hernisi tedavisinde, intradiskal
enjeksiyon ve paravertebral kas içi enjeksiyon
şeklinde yaygın olarak kullanılmaktadır. Bu sistematik
derlemenin amacı, lomber disk herniasyonu tedavisinde
ozon tedavisinin etkinliğinin randomize kontrollü
çalışma sonuçlarına göre değerlendirilmesidir.
Pubmed, Google Akademik ve Science Direct veritabanlarında
yapılan arama sonucunda elde edilen
105 makale incelenerek 9 adet randomize kontrollü
araştırma sistematik derleme kapsamına alınmıştır.
Araştırmalarda ozonun intradiskal ya da paravertebral
yolla, 20 μg/ml ile 60 μg/ml arasında değişen konsantrasyonlarda
kullanıldığı görülmüştür. Araştırmalarda
sadece ozon uygulaması yapılabildiği gibi, bazı araştırmalar
ozon enjeksiyonunun etkisini başka tedavi
yöntemleriyle kombinasyon halinde kullandığı saptanmıştır.
Araştırmalarda değerlendirme parametresi
olarak genelde ağrının görsel analog skala (GAS) ile
ölçüldüğü görülmüştür. Randomize kontrollü çalışma
sonuçları, ozon terapinin lomber disk hernisi tedavisinde
konvansiyonel ilaç tedavisine kıyasla daha etkili
olduğu ve minimal invaziv tedavilere eklendiğinde ise
tedavi etkinliğini artırdığı görülmüştür. Ayrıca cerrahiye
kıyasla daha az hastanede yatış süresine ve daha
düşük tedavi maliyetine yol açmaktadır.

Keywords

bel ağrısı, ozon, Lomber disk hernisi

References

• 1. Zhang W, Wang Z, Yin J, Bai Y, Qiu F, Zhang H, et al. Clinical Study of Radiofrequency Ozone and Injection of Anti-inflammatory Analgesic Solution into the Internal Orifice of Nerve Root Combined with Traditional Chinese Medicine Hook Operation in the Treatment of Lumbar Disc Herniation. Unpublished research (Research Square). 2021;DOI: 10.21203/rs.3.rs-138941/v1
• 2. Elvis AM, Ekta JS. Ozone therapy: A clinical review. Journal of natural science, biology and medicine. 2011;2(1):66-70
• 3. Tirelli U, Cirrito C, Pavanello M, Piasentin C, Lleshi A, Taibi R. Ozone therapy in 65 patients with fibromyalgia: an effective therapy. Eur Rev Med Pharmacol Sci. 2019;23(4):1786–8.
• 4. Andreula CF, Simonetti L, De Santis F, Agati R, Ricci R, Leonardi M. Minimally invasive oxygen-ozone therapy for lumbar disk herniation. Am J Neuroradiol. 2003;24(5):996–1000.
• 5. Buric J, Rigobello L, Hooper D. Five and ten year follow-up on intradiscal ozone injection for disc herniation. Int J spine Surg. 2014;8:17. DOI: 10.14444/1017.
• 6. Bocci V, Borrelli E, Zanardi I, Travagli V. The usefulness of ozone treatment in spinal pain. Drug Des Devel Ther. 2015;9:2677.
• 7. de Andrade RR, de Oliveira-Neto OB, Barbosa LT, Santos IO, de Sousa-Rodrigues CF, Barbosa FT. Effectiveness of ozone therapy compared to other therapies for low back pain: a systematic review with meta-analysis of randomized clinical trials. Rev Bras Anestesiol. 2019;69:493–501.
• 8. Rimeika G, Saba L, Arthimulam G, Della Gatta L, Davidovic K, Bonetti M, et al. Metanalysis on the effectiveness of low back pain treatment with oxygen-ozone mixture: Comparison between image-guided and non-image-guided injection techniques. Eur J Radiol open. 2021;8:100389.
• 9. Seyam O, Smith NL, Reid I, Gandhi J, Jiang W, Khan SA. Clinical utility of ozone therapy for musculoskeletal disorders. Med Gas Res. 2018;8(3):103.
• 10. Muto M, Giurazza F, Silva RP, Guarnieri G. Rational approach, technique and selection criteria treating lumbar disk herniations by oxygen–ozone therapy. Interv Neuroradiol. 2016;22(6):736– 40.
• 11. Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162(11):777–84.
• 12. Sucuoğlu H, Soydaş N. Does paravertebral ozone injection have efficacy as an additional treatment for acute lumbar disc herniation? A randomized, double-blind, placebo-controlled study. J Back Musculoskelet Rehabil. 2021;34(5):725–33.
• 13. Melchionda D, Milillo P, Manente G, Stoppino L, Macarini L. Treatment of radiculopathies: a study of efficacy and tollerability of paravertebral oxygen-ozone injections compared with pharmacological anti-inflammatory treatment. J Biol Regul Homeost Agents. 2012;26(3):467–74.
• 14. Perri M, Marsecano C, Varrassi M, Giordano AV, Splendiani A, di Cesare E, et al. Indications and efficacy of O2-O3 intradiscal versus steroid intraforaminal injection in different types of disco vertebral pathologies: a prospective randomized double-blind trial with 517 patients. Radiol Med. 2016;121(6):463–71.
• 15. Niu T, Lv C, Yi G, Tang H, Gong C, Niu S. Therapeutic Effect of Medical Ozone on Lumbar Disc Herniation. Med Sci Monit Int Med J Exp Clin Res. 2018;24:1962–9.
• 16. Perri M, Grattacaso G, di Tunno V, Marsecano C, Gennarelli A, Michelini G, et al. T2 shine-through phenomena in diffusion-weighted MR imaging of lumbar discs after oxygen-ozone discolysis: a randomized, double-blind trial with steroid and O2-O3 discolysis versus steroid only. Radiol Med. 2015;120(10):941–50.
• 17. Clavo B, Robaina F, Urrutia G, Bisshopp S, Ramallo Y, Szolna A, et al. Ozone therapy versus surgery for lumbar disc herniation: A randomized double-blind controlled trial. Complement Ther Med. 2021;59:102724.
• 18. Kelekis A, Bonaldi G, Cianfoni A, Filippiadis D, Scarone P, Bernucci C, et al. Intradiscal oxygen-ozone chemonucleolysis versus microdiscectomy for lumbar disc herniation radiculopathy: a non-inferiority randomized control trial. The spine journal. 2022;22(6):895-909.
• 19. Ankur J, Rastogi V, Sujeet G, Ganesh S. Comparative study of oxygen ozone therapy, percutaneous radiofrequency thermocoagulation and their combined effects for the treatment of lumbar disc herniation. J Adv Res Biol Sci. 2014;6(2):153–8.
• 20. Jordan J, Konstantinou K, O'Dowd J. Herniated lumbar disc. BMJ clinical evidence. 2009;2009:1118
• 21. Borrelli E. Mechanism of action of oxygen ozone therapy in the treatment of disc herniation and low back pain. In: Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves. Springer; 2011. p. 123–5.
• 22. Zhang Y, Ma Y, Jiang J, Ding T, Wang J. Treatment of the lumbar disc herniation with intradiscal and intraforaminal injection of oxygen-ozone. J Back Musculoskelet Rehabil. 2013;26(3):317–22.